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If Andy Burnham ever makes it to Number 10, he'll discover what every Prime Minister before him has discovered…
…the NHS isn't really a health service, it’s …
… a demand management service.
Every reform, every reorganisation, every productivity drive, every inspection regime and every waiting-list target eventually crashes into the same reality.
Demand rises faster than capacity. The waiting list is simply the visible manifestation of that reality.
Added to which presently, the Service is coping with the Kamikaze bonkersness of a very silly boy.
Burnham is no stranger to the NHS. As Health Secretary he presided over a very different service, in very different times.
Recently, Nail Dickson and I interviewed him for our podcast. It was clear his thinking has evolved. (Well worth a listen)
His philosophy is built around prevention, neighbourhood health, social care, housing and public health.
In simple terms, he wants to stop people needing the NHS in the first place.
Good. So do I.
For years I have argued the NHS spends too much time repairing damage and not enough time preventing it. The future has to be about wellness (Click here for free book download), not simply illness, but…
… there’s a problem.
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Prevention is tomorrow's answer.
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Politics is judged today.
At the moment, more than seven million people are on NHS waiting lists. Millions of people are not thinking about wellness.
They are thinking about;
- getting in,
- getting diagnosed,
- getting fixed up,
- getting out and
- getting on with their lives.
That is the political reality, waiting for whoever occupies Downing Street.
Burnham's instinct is different from most politicians. He doesn't start with hospitals. He starts with the causes of hospital demand, and…
… he knows something many politicians struggle to admit.
The NHS's biggest problem is not how it’s run. The biggest problem is that it has become society's default answer to almost every failure elsewhere;
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Poor housing becomes an NHS problem.
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Loneliness becomes an NHS problem.
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Social care becomes an NHS problem.
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Obesity becomes an NHS problem.
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Mental health becomes an NHS problem.
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Poverty becomes an NHS problem.
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Lifestyle becomes an NHS problem.
Every unresolved issue eventually arrives at the hospital front door.
That’s why the waiting list matters. Not because it tells us how well hospitals are performing, but…
… because it tells us what happened before the patient arrived.
The waiting list is not a measure of NHS performance. It is a measure of everything that happened before the patient turned up...
... it's a measure of government policies., lack of policies, neglect, interference and meddling.
Viewed through that lens, the NHS doesn't really have a waiting-list problem. It has a demand-and-capacity problem that manifests itself as a waiting list.
The causes are familiar enough;
- an ageing population,
- increasing clinical complexity,
- workforce shortages,
- constrained social care,
- rising public expectations and…
…at the bottom of it all sits money.
Either;
Money to invest in technology, productivity and modern ways of working.
Or …
Money to launch another blunt-force assault on waiting lists through overtime, temporary capacity and special initiatives.
Burnham has already said he would be constrained by existing fiscal-rules. That means there’ll be limits, and…
… there lies the tension.
Burnham's instincts are probably right. The future lies in prevention, wellness, housing, public health and social care.
The problem is that voters do not experience the future. They experience today.
They experience the pain in their hip, the lump they need checked, the operation they cannot get and the months spent waiting.
Burnham wants to reduce demand. The public wants treatment.
One is a strategy. The other is a symptom.
The next Prime Minister will have to deal with both, because…
… until demand and capacity stop moving further apart, the waiting list will continue to act as the nation's receipt for everything we failed to fix earlier.
The question is; can any Prime Minister ever get ahead of demand?
Maybe…. three things to fix;
Cause.
Shift the fulcrum point of funding to favour primary care and councils. They have the greatest influence on the causes of demand.
Capacity.
For a largely manual system, the NHS is probably close to peak performance. The next leap forward will not come from asking people to work harder. It will come from a digital-first NHS.
Doin' it.
The people who will have to make it happen; protect the front line... fund it properly and make it fun to work there.
Cause. Capacity. Doin' it.
Miss one and the other two won't be enough.
Get all three right and there is at least a chance.
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